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OKU REVIEW
CHAPTER 24 – SHOULDER
INSTABILITY
24 year male presents with a traumatic
shoulder dislocation that was reduced.
He is now 3 days out and in a sling.
Which of the following is true?
A. There is a high likelihood of having a rotator cuff tear.
B. He will most likely have the same if not better quality of life
and sporting activities once rehabilitation starts.
C. He will likely dislocate his shoulder again.
D. All of the above are true
24 year male presents with a traumatic
shoulder dislocation that was reduced.
He is now 3 days out and in a sling.
Which of the following is true?
A. There is a high likelihood of having a rotator cuff tear.
B. He will most likely have the same if not better quality of life
and sporting activities once rehabilitation starts.
C. He will likely dislocate his shoulder again.
D. All of the above are true
Describe the difference between
laxity and instability.
Describe the difference between
laxity and instability.
Laxity = objective measurement of joint mobility
Instability = subjective symptomatology associated with
excessive joint motion.
Which of the following are
important regarding patient
history?
A. Direction of instability.
B. Number of episodes of instability.
C. Both A and B.
Which of the following are
important regarding patient
history?
A. Direction of instability.
B. Number of episodes of instability.
C. Both A and B.
The anterior apprehension test is
used to test/evaluate what type
of instabilty?
The anterior apprehension test is
used to test/evaluate what type
of instabilty?
Anterior instability
What test is used in conjunction
with apprehension test?
What test is used in conjunction
with apprehension test?
Relocation test.
What special test is used to
evaluate posterior instability?
What special test is used to
evaluate posterior instability?
Jerk test.
The sulcus sign evaluates what
type of instability?
The sulcus sign evaluates what
type of instability?
Inferior instability.
What anatomic structure is often
incompetent when the sulcus sign
is present with shoulder ext.
rotation?
What anatomic structure is often
incompetent when the sulcus sign
is present with shoulder ext.
rotation?
Rotator interval.
What x-ray view is paramount
for evaluation of shoulder
dislocations?
What x-ray view is paramount
for evaluation of shoulder
dislocations?
Axillary lateral.
Match the x-ray view with the
appropriate pair.
A. West Point
B. Stryker Notch
C. Zanca
1. Hill-Sachs lesion
2. Bony Bankart
3. AC Joint
Match the x-ray view with the
appropriate pair.
A. West Point – 2. Bony Bankart
B. Stryker Notch – 1. Hill-Sachs lesion
C. Zanca – 3. AC Joint
What position of the shoulder
reapproximates the anterior
labrum anatomically?
Internal rotation (as if in a sling)
Slight flexion
External rotation
Neutral rotation and extension
What position of the shoulder
reapproximates the anterior
labrum anatomically?
Internal rotation (as if in a sling)
Slight flexion
External rotation
Neutral rotation and extension
What complications results from
nonanatomic reconstructions of the
anterior shoulder (Putti-Platt and
Magnuson-Stack)?
What complications results from
nonanatomic reconstructions of the
anterior shoulder (Putti-Platt and
Magnuson-Stack)?
1. Significant loss of motion
2. OA
According to a recent study involving the
Bristow-Latarjet procedure, what
radiograph was the most accurate view
for revealing OA?
According to a recent study involving the
Bristow-Latarjet procedure, what
radiograph was the most accurate view
for revealing OA?
Subcoracoid projection (angeld inferiorly 45 degrees from
above)
The true AP view tended to minimize/miss arthritic changes.
What is the first line treatment
of multidirectional instability?
What is the first line treatment
of multidirectional instability?
Aggressive Physical Therapy
Maximize strength and balance of the dynamic stabilizers (cuff,
delt, scap)
Patient Education
Activity Modification
Match the structure with the
appropriate restraint.
A. Posterior Band IGHL
B. Rotator Interval (Coracohumeral and superior GHL)
1. Posterior restraint with the arm flexed, add, IR.
2. Posterior restraint with the arm in abd
Match the structure with the
appropriate restraint.
A. Posterior Band IGHL – resists posterior translation with
the arm in abd (A-2).
B. Rotator Interval (Coracohumeral and superior GHL) –
Posterior restraint with the arm flexed, ADD, IR (B-1).
What procedure is performed
after primary anteroinferior
instability treatment fails?
What procedure is performed after
primary anteroinferior instability
treatment fails?
Bristow-Latarjet repair
Coracoid to the anterior glenoid rim transfer.
Provides bony reinforcement as well as a soft-tissue sling of
conjoined tendons when the arm is abd and ER.
Describe the 6 types of AC Joint
Separation
Describe the 6 types of AC Joint
Separation
Type I
Nondisplaced sprain
Type II
Tear AC lig with intact CC lig
Mild clavicular displacement
Type III
Comple tear AC and CC lig
100% superior displacement of the clavicle
Type IV
Posterior displacement
Type V
100-300% superior displacement
Type VI
Inferior displacement locked beneath the coracoid
What type is basically always
treated nonsx?
What type is basically always
treated nonsx?
Type I
Which types basically always get
treated with sx?
Which types basically always get
treated with sx?
Types IV, V, VI
What x-ray view is used to help
evaluate SC instability?
What x-ray view is used to help
evaluate SC instability?
Serendipity view
40 degree cephalic tilt
BUT… CT is accepted as the study of choice.
What direction may lead to
major vascular/chest injury?
What direction may lead to
major vascular/chest injury?
Posterior SC dislocations